[PHARM] Antidepressants [Segars] Flashcards
ALL antidepressants either are known to be or can be associated with a _____________________
ALL antidepressants either are known to be or can be associated with a WITHDRAWAL SYNDROME
What are the symptoms of withdrawal syndrome?
“F-I-N-I-S-H”
F= Flu-like symptoms
I= Insomnia
N= Nausea
I= Imbalance
S= Sensory disturbances
H= Hyperarousal
Special indications for ‘Antidepressant’ meds:
Drug for nicotine withdrawal
Nicotine withdrawl = Bupropion
Special indications for ‘Antidepressant’ meds:
Drug for enuresis
Enuresis (involuntary urination) = Imipramine
Special indications for ‘Antidepressant’ meds:
Drug for Diabetic peripheral neuropathy, Fibromyalgia and Chronic MSK pain
Diabetic peripheral neuropathy, Fibromyalgia and Chronic MSK pain = Duloxetine
Special indications for ‘Antidepressant’ meds:
Drug for Stress Incontinence
Stress incontinence = Duloxetine
What does SSRI stand for?
Selective Serotonin Reuptake Inhibitor
What are the (7) SSRIs?
Fluoxetine
Paroxetine
Sertraline
Citalopram
Escitalopram
Vilazodone
Vortioxetine
What should you remember about the SSRIs that start with a “V”?
What are they?
Make a “V” with your fingers, makes a number two. Remember that these drugs have TWO mechanisms of action. In addition to the standard SSRI MOA, they have another!
Vilazodone (also partial agonist on 5-HT1A)
Vortioxetine (also partial agonist on 5-HT1B and full agonist on 5-HT1A and full antagonist on 5-HT1D,3,7)
Where do SSRI’s act?
SSRI’s act on the SERT transporter on the presynaptic neuron
Why are SSRI’s the first line class of drugs used?
As a class, fewer side effects and risks than other classes (eg TCAs)
Much less impact on histamine, muscarinic and adrenergic receptors
What are the common side effects associated with SSRIs?
- CNS (sedation or insomnia)
- Sexual dysfunction
- Weight gain
- ACUTE WITHDRAWAL REACTIONS
What are some of the rare side effects of SSRIs?
Serotonin syndrome (sweating, hyperreflexia, shivering, tremors)
Suicidality
Which SSRI has the MOST drug-drug interactions?
Fluoxetine
Which two SSRI’s have the LEAST number of drug-drug interactions?
Vortioxetine
Escitalopram
What does SNRI stand for?
Serotonin and Norepinephrine reuptake inhibitor
Where do SNRI’s act?
What are the 3 non-efficacy related receptors that are affected with TCA’s?
- Histamine (H1)
- Muscarinic (cholinergic)
- Alpha1 (adrenergic)
What are the 3 key TCA system based side effects?
- Cardiovascular (alpha) : Tachycardia, orthostatic hypotension, dysrhythmias
- Anticholinergic (muscarinic) : Dry mouth, urinary retention, blurred vision
- CNS (histamine) : Sedation/fatigue, dizziness/seizures
What are the “3 C’s” associated with TCA overdose?
Coma
Cardiotoxicity
Convulsions
What does SARA stand for?
Seratonin Adrenergic Receptor Antagonists
What are the (3) SARA drugs?
Mirtazapine
Nefazodone
Trazodone
Where do SARAs act?
What are the side effects of SARAs?
CNS (sedation)
Orthostatic hypotension
Weight gain
What does NDRI stand for?
Norepinephrine and Dopamine Reuptake inhibitor
What is the (1) NDRI?
Bupropion
What is the major side effect of NDRIs?
Seizures
What does MAOI stand for?
Monoamine oxidase inhibitors
What are the (4) MAOIs?
Isocarboxazid
Phenelzine
Selegiline
Tranylcypromine
Where do MAOIs act?
What is the one selective MAOI?
Selegiline
(Starts with an S for selective)
What are the side effects of MAOIs?
Orthostatic hypotension
Sexual dysfunction
Weight gain
Insomnia/agitation/nervousness
Why do most physicians choose not to use MAOIs?
There is a 2 week wash out period, where you need to remove the previous anti-depressant in order to add MAOIs
What is the MAJOR concern when using MAOIs?
Hypertensive crisis
(has to do with over ingestion of tyramine in diet)
What are the symptoms/signs of a hypertensive crisis?
Severe headache
N/V
Sweating/severe anxiety
Nosebleeds
Tachycardia
Chest pain
Changes in vision
Shortness of breath
Confusion
What are the two miscellaneous agents?
Esketamine
Brexanolone
What is the MOA of esketamine?
NMDA receptor antagonist
What is esketamine indicated for?
Treatment-resistant depression in conjunction with ongoing anti-depressant therapy
What is the MOA of brexanolone?
GABA(a) receptor positive allosteric modulator
What is the indication for brexanolone?
Post-partum depression
What are the two categories of mood stabilizer drugs?
Anti-seizure agents
Miscellaneous
What are the (3) anti-seizure agents used to treat mood disorders?
Carbamazepine
Lamotrigine
Divalproex/Valproic acid
What is the (1) miscellaneous mood stabilizer drug?
Lithium
What are the top 3 actions of lithium?
Brain structure
Neurotransmitter modulation
Intracellular changes
How does lithium change the brain structures?
Has neuroprotective/neuroproliferative effects
How does lithium affect neurotransmitter modulation?
Lithium inhibits dopamine neurotransmission
MOA of lithium?
A monovalent ion
Common system affected by lithium?
RENAL
What is the major CYP40 inducer?
Carbamazepine
